title: Impact of glomerular filtration rate on clinical outcomes after carotid artery revascularization in 11,832 patients from the CARE registry.
abstract: OBJECTIVE
  The aim of this study was to assess the association of kidney function with carotid artery revascularization outcomes in a large contemporary database.
  
  
  BACKGROUND
  Chronic kidney disease (CKD) is associated with increased mortality and adverse cardiovascular events after coronary intervention. There are limited data evaluating the association between CKD and adverse events among patients undergoing carotid artery revascularization procedures.
  
  
  METHODS
  The Carotid Artery Revascularization and Endarterectomy (CARE) Registry is a voluntary registry of 168 hospitals. Using data from the CARE Registry, we examined registry patients undergoing carotid artery revascularization by either carotid endarterectomy (CEA) or carotid artery stenting (CAS) from May 2005 through March 2010. Patients were divided into four groups according to their glomerular filtration rate (GFR), as estimated by the Modification of Diet in Renal Disease Study Group equation using preprocedural serum creatinine levels.
  
  
  RESULTS
  The analysis included 11,832 patients who underwent carotid revascularization (6,899 CAS and 4,933 CEA). Patients with lower GFR were older, more frequently female, had more comorbidities, including hypertension, dyslipidemia, peripheral arterial disease, diabetes mellitus, chronic lung disease, ischemic heart disease, heart failure, and reduced left ventricular function, and were more likely to undergo CAS than CEA. In the overall population, CKD was associated with higher unadjusted in-hospital and 30-day rates of the combined endpoint of death, stroke, and myocardial infarction and the individual endpoint of stroke. After adjustment for baseline and preprocedural characteristics, CKD was not an independent predictor of adverse events in either CAS or CEA.
  
  
  CONCLUSIONS
  Patients with CKD have a greater number of comorbidities and worse unadjusted in-hospital and 30-day outcomes; CKD was not, however, an independent predictor of in-hospital and 30-day outcomes after carotid artery revascularization.
authors.affiliation: Department of Medicine, Division of Cardiovascular Diseases, Stony Brook University Medical Center, Stony Brook, New York.
authors.forename: Luis
authors.initials: L
authors.lastname: Gruberg
authors.forename: Allen
authors.initials: A
authors.lastname: Jeremias
authors.forename: John H
authors.initials: JH
authors.lastname: Rundback
authors.forename: H Vernon
authors.initials: HV
authors.lastname: Anderson
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.forename: Kevin F
authors.initials: KF
authors.lastname: Kennedy
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Rosenfield
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D015415:Biomarkers / Q000097:blood; D002340:Carotid Artery Diseases / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D015897:Comorbidity; D003404:Creatinine / Q000097:blood; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000401:mortality; D005260:Female; D005919:Glomerular Filtration Rate; D017052:Hospital Mortality; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007674:Kidney Diseases / Q000097:blood / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D012042:Registries; D012307:Risk Factors; D015607:Stents; D020521:Stroke / Q000209:etiology / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D003404:Creatinine
keywords: cerebrovascular disease; chronic renal insufficiency; peripheral vascular disease